| NPI | 1598817322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 3321) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 106H00000X Marriage & Family Therapist (Licence: MA 373) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2024-03-07 |